Enterobacteriaceae, Klebsiella and Serratia, while the most common Gram-positive bacteria were staphylococci and streptococci. The microbiota of the NG-feeding tube was overall infant-specific, rather than dependent on the duration of use. Furthermore, we determined that reoccurring species from the individual infant represented the same strain and that several strains were common for more than one infant. Our findings indicate that bacterial profiles found in NG-tubes of neonates are host-specific, not dependent on the duration of use and strongly influenced by the environment.Nasogastric feeding tubes (NG-tubes) from neonates contain potentially pathogenic bacteria. Using culture-based techniques, we have previously determined that the usage duration of NG-tubes did not impact the colonization of the nasogastric tubes. In the present study, we performed 16S rRNA gene amplicon sequencing to evaluate the microbial profile of 94 used nasogastric tubes collected from a single neonatal intensive care unit. Using culture-based whole genome sequencing, we as-sessed whether the same strain persisted in NG-tubes collected from the same neonate across different time-points. We found that the most commonly occurring Gram-negative bacteria were  At birth, the newborn infant is immediately confronted with immense microbial pressure from the outside world, leading to colonization of the mucosal membranes and the skin. When an infant is admitted to a neonatal intensive care unit (NICU), their natural colonization pattern is compromised compared to newborns placed in the arms of the mother . The maiEnterococcus faecalis, Enterobacter cloacae, Serratia marcescens and Klebsiella pneumoniae, have all previously been found in NG-tubes from neonates [Nasogastric tubes (NG-tubes) used to ensure nutritional intake in sick neonates and preterm infants are indwelling foreign bodies, and biofilm formation occurs within 24 h of placement . The NG-neonates ,8. The Nneonates , we examneonates . We founneonates .Hence, we wondered if the biofilm consisted mainly of bacteria from the stomach , from the environment or from the milk fed via the NG-tube.In the present study, we performed a detailed molecular analysis of the microbiota collected from NG-tube flushes from our previous work  to compa9 CFU Lactobacillus rhamnosus GG (LGG) + 108 CFU Bifidobacterium animalis ssp. lactis (BB12)) from the third day of life.This prospective and observational study was conducted at the neonatal intensive care unit, Rigshospitalet, Copenhagen, Denmark. The inclusion criteria of enrolled infants were (1) admission to the neonatal department and (2) a resident NG-tube at the time of inclusion. The methods related to feeding tube collection and culturing were previously described . In shorThe study was approved by the Danish Ethical Committee (Protocol number: H-1-2014-009), and written informed consent was sought from one of the parents according to Danish law.The used NG-tubes were flushed with 1 mL NaCl to mimic a 1 mL meal given through the NG-tube. The flush was analyzed with both molecular and culture-based methods. Bacterial isolates were cultured and identified as previously described . Unique ® dsDNA HS Assay Kit . The measurement was performed using a Varioskan Flash Multimode Reader . Fluorescence was measured at 485/530 nm. The DNA concentration was normalized to 10 ng/μL and subjected to library preparation using two-step PCR.The bacterial community of 94 NG-tubes was determined using tag-encoded 16S rRNA gene amplicon (V3 region), NextSeq-based , high-throughput sequencing. Cellular DNA was extracted from 200 μL of the flush from the feeding tube using a PowerSoil DNA Isolation Kit  according to the manufacturer’s instructions, including an initial bead-beating step using FastPrep-24™ 5G . The DNA concentration was evaluated using a QubitThe V3 region (~190 bp) of the 16S rRNA gene was amplified using the primers nxt388_F: (5′-TCGTCGGCAG CGTCAGATGT GTATAAGAGA CAGACWCCTA CGGGWGGCAGCAG-3′) and nxt518_R: (5′-GTCTCGTGGG CTCGGAGATG TGTATAAGAG ACAGATTACC GCGGCTGCTGG-3′), compatible with the Nextera Index Kit . The first PCR round was performed in 25 μL of final reaction volume, composed of 12 μL of AccuPrimeTM SuperMix II , 0.5 μL of each primer , 5 μL of genomic DNA (~10 ng/ul) and nuclease-free water up to 25 μL. The PCR1 temperature profile was as follows: 95 °C for 2 min, followed by 35 cycles of 95 °C for 15 s, 55 °C for 15 s and 68 °C for 40 s. Lastly, a final extension step was held in 68 °C for 5 min .E. coli genomic DNA) and negative controls (a no template control (NTC) and a negative extraction control). Prior to libraries pooling, clean constructs were quantified using a Qubit fluorometer , and finally, PCR2 products were mixed equimolarly. A single flow cell of a 150 bp pair-ended NextSeq  sequencing run was performed according to manufacturer’s instructions.In order to incorporate sample-specific barcodes, a second PCR round was performed containing 12 μL of Phusion High-Fidelity PCR Master Mix , 2 μL of the corresponding P5 and P7 primers , 2 μL of the PCR1 product and nuclease-free water to a final volume of 25 μL. The PCR2 temperature profile was as follows: 98 °C for 1 min, followed by 12 cycles of 98 °C for 10 s, 55 °C for 20 s and 72 °C for 20 s. A final extension step was held in 72 °C for 5 min . The amplified fragments with adapters and tags were purified using AMPure XP beads , according to the manufacturer’s manual. Each PCR round was conducted in the presence of positive , as described above. The DNA concentration was normalized to 1 ng/μL and subjected to library preparation using the Nextera XT DNA Library Preparation Kit , according to the manufacturer’s instruction, and sequenced with the NextSeq500 using Mid Output Kit v2.5 . The 16S rRNA gene amplicon library and WGS library were sequenced simultaneously on the NextSeq500 platform in 1:1 proportion.To determine whether a specific strain of bacteria occurred repeatedly in each infant’s NG-tube, we investigated the NG-tubes of nine extremely preterm infants, from whom four or more NG-tubes were collected. In 8 of the 9 infants who fulfilled this criterion, the same bacterial species reoccurred in 50% or more of the NG-tubes . The reot-test-based approach employing the non-parametric (Monte Carlo) method (999 permutations) implemented in the compare alpha diversity workflow .The raw dataset containing pair-ended reads with corresponding quality scores were merged and trimmed using fastq_mergepairs and fastq_filter scripts implemented in the VSEARCH pipeline , using tThe raw reads were trimmed from adaptors, barcodes and low-quality fragments using Trimmomatic v0.35 . The highttps://www.ncbi.nlm.nih.gov/sra, accessed on 6 April 2023) under the Bioproject: PRJNA951070.Raw sequencing data (fastq) for the 16S rRNA gene amplicon sequencing and WGS data of 45 isolates were deposited in the NCBI SRA database , and the postnatal median age at the time of collection was 37 d (range = 1–119 d). The details regarding culture-specific findings have been previously described  [Enterobacteriaceae, Klebsiella and Serratia spp., and the most common GP bacteria were staphylococci and streptococci. We also observed the probiotic bacteria Bifidobacterium animalis and different types of lactobacilli in several samples  high-throughput sequencing indicated high level of similarity between the microbial community of NG-tubes that originated from the same infant . The NG- samples . The PER samples A,B. The  samples C,D or fe samples E.Klebsiella oxytoca, Enterococcus faecium and Staphylococcus epidermidis showed a high level of OrthoANI similarity, ranging between 99.7% and 100%, characteristic of being similar at a strain level . Although 16S rRNA gene amplicon sequencing has disclosed probiotics in more samples than the culture-dependent methods, it is unknown whether these were viable bacteria.When using culture-dependent methods, only limited proportions of probiotic bacteria were found (Furthermore, it is important to stress that since the WGS data rely on culture-dependent methods, our conclusions on bacterial taxonomy, presence/absence and relative abundance are limited to bacteria that favored the specific growing conditions.The ultimate clinical question is whether bacteria of NG-tubes are potential pathogens for the infant. For immune-competent individuals with a low pH in the stomach, they may not be a big threat, but this may be different for the preterm population. Previous studies showed that once a pathogen occurs in a blood stream infection of one infant, it is likely to occur in another infant in the same unit . NG-tubeThis was a follow-up on a previous study, where culture-based methods were used to determine the bacterial load from NG-tubes. The present study was the first study using molecular methods to determine the microbiota of used NG-tubes and relate it to the duration of use. This was a convenience study, as we collected all used NG-tubes in our department for a limited period, thus giving us a broad study group, both term and preterm. Infants born <30 weeks GA received probiotics, which may have affected the colonization of the feeding tube in these infants. In the future, it may be interesting to investigate which factors are most likely to determine which infants end up with the same bacteria in their NG-tubes, e.g., sharing the room, sharing caregivers and so forth. For that, further research is required to test other potential sources of bacterial transmission, such as, for example, the diaper zone, skin or breast milk. By creating more knowledge in this field, we will be able to understand how microbiota is shared between hospitalized infants and prevent transmission of pathogenic bacteria.The microbiota present in the NG-tubes of infants in a neonatal department seemed to be infant-specific, rather than dependent on the duration of use. The bacteria may originate from the microbiota of the stomach of the infant itself when gastric aspirates are pulled into the tube before a meal is given. However, the same bacterium was present in the NG-tubes of different infants, indicating that there may be a common source for the colonization, which could be the caretakers or the NICU environment.


To compare the results of operations of commercial uterine manipulators. Considering that the optimal uterine manipulator is still not found, our goal was to give an idea for gynecologists to choose the most suitable uterine manipulator for their purposes and expectations.Between January 2016 and September 2021, 294 laparoscopic hysterectomy cases met the inclusion criteria and were operated in İzmir Katip Çelebi University Atatürk Training and Research Hospital Gynecology and Obstetrics Clinic. They were divided into four groups according to the type of manipulator used. Group-1 (RUMI-I), Group-2 (Clermont-Ferrand), Group-3 (sharp intrauterine curette-tenaculum), and Group-4(without uterine manipulator). All four groups were compared with operation time, hospital stay, absolute change in hemoglobin (g/dl), and per-op complications.Considering the operation times in all groups, the mean operation time in the first Group-was 180 minutes (98-349); in Group-2 was 159 minutes (96-564); in the 3rd Group was 178 minutes (141-540); in the 4th Group was 189 minutes (115-453). The group with the shortest operation time was Group-2; the difference was statistically significant (p=0.015). In general terms, the effect of all manipulators on patient parameters wasn’t very different. Clermont-Ferrand seems more advantageous than others in making the surgeon’s work more straightforward regarding operation time only.In our study, the choice of uterine manipulator did not affect the surgical results except for the duration of the operation. The personalization of uterine manipulators according to the needs of the surgery and the easiness of use of the surgeon should be at the forefront. Hysterectomy is one of the most common gynecological surgical procedures performed abdominal, vaginal, and laparoscopic.4In laparoscopic hysterectomy cases, which have become more preferred with the rapid development of technology in recent years, in addition to the surgeon’s experience, the characteristics of the instruments and devices used have gained importance, and various companies have produced different products. The ideal uterus manipulator is cheap and convenient, eliminating the need for an assistant and offering the surgeon a good range of motion.7Clermont-Ferrand (CF) uterine manipulator, handle with fixing screw; manipulator bar with five locking positions between 0° and 90°; silicone sealant; it is a reusable tool consisting of a rotating ceramic head.9The RUMI system consists of Koh cervical cap and Koh colpo-pneumo-occlusive. RUMI manipulator is a versatile uterine manipulator with perfect uterine manipulation in the anterior, posterior and lateral planes. It also helps in the straightforward identification of the vaginal fornix. It helps to complete laparoscopic dissection of the vagina much more easily, providing greater efficiency and less blood loss while eliminating difficulties with vaginal access. This enhanced uterine mobility also accelerates utero-vesical peritoneal dissection and downward displacement of the bladder.Patients who were operated at Izmir Katip Çelebi University Atatürk Training and Research Hospital Gynecology and Obstetrics Clinic between January 2016 and September 2021 were included in the study. A total of 356 patients underwent laparoscopic hysterectomy operations. This study was conducted with 294 who met the inclusion criteria. Written informed consent was obtained from all patients. Information about the patients was obtained from the records of İzmir Katip Çelebi University Atatürk Training and Research Hospital and analyzed retrospectively. Ethics committee approval was received for this study from Izmir Katip Çelebi University Medical Ethics Committee .Bimanual pelvic examination, a transvaginal ultrasound, examination with cervicovaginal smear, and endometrial sampling were performed before the operation. Patients with suspected malignancy as a result of smear and endometrial sampling were excluded from this study. Six cases due to malignancy were excluded from the study.Those who underwent TLH(n=36), TLH+bilateral salpingo-oophorectomy (n=294) and TLH+bilateral salpingo-oophorectomy + Additional procedures  (n=20) for benign reasons were evaluated. Cases, where an additional procedure was applied, were excluded from the study because it may affect the operation time, hospital stay, and hemoglobin changes.Two hundred ninety-four LH cases were analyzed in terms of age and operation indications retrospectively and divided into four groups according to the preferred manipulator type; Group-1  (n=124), Group-2  (n=70) and Group-3 (sharp intrauterine. Curette-tenaculum) without commercial uterine manipulator (n=54) and Group-4 (without uterine manipulator) (n=46). The same surgical team performed all operations. In the third group, a commercial uterine manipulator hasn’t used; uterine manipulation was achieved with a Tenaculum -which is a single tooth forceps- at the 11 o’clock point of the cervix and inserting a number five sharp curette into the uterus after cervical dilatation, and fixing the handle to the tenaculum with the help of gauze. In the fourth group, we didn’t use any type of uterine manipulator.All four groups were evaluated in terms of age and operation indications. Also, they were compared with parameters such as operation time, hospital stay (days), Pre-op hemoglobin-post-op hemoglobin values, absolute change in hemoglobin [ difference between the preoperative hemoglobin (Hb) (g/dl) value and the postoperative Hb(g/dl) value], per-op complications , uterine length in the pathology specimen.Data including preoperative evaluations, imaging, surgery notes, and pathology reports were obtained from patient management system records. Operation times were described as minutes per the information in the anesthesia follow-up forms. The uterine length was determined as centimeters, according to histopathological examination results.UM was placed in all patients in the dorsal lithotomy position under general anesthesia by the surgeon. The abdomen was infused with a Veress needle. A 10 mm trocar was inserted through the umbilicus. Two 5mm trocars were placed on both sides, 1/3 lateral of the imaginary line between the right and left anterior iliac superior (SIAS) and the umbilicus. A 5mm trocar was placed at the midpoint of both SIAS. The infundibulopelvic ligaments were coagulated, sealed, and cut. The uterovesical fold was dissected from the anterior vaginal wall. Uterine arteries were coagulated and cut bilaterally. Ligasure  was used for coagulation and cutting. Colpotomy was performed with a monopolar L-hook cautery device or a harmonic scalpel . The vagina was sutured vaginally with 1.0 Vicryl using a simple intermittent suture technique.Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software . Descriptive variables were presented as median, minimum, and maximum values. The Kruskal-Wallis test compared the means of more than two independent groups in continuous variables determined by measurement, and the Bunn-Bonferroni test for post hoc pairwise comparisons. Pearson Chi-square test was used for categorical variables. The significance level was accepted as 0.05.The mean age of the four groups was similar. The mean age among the groups, respectively; was 48 years; 48 years; 52 years; 48 years (p=0.616). Also, pre-op hemoglobin values of all groups were similar in all groups, respectively, 12.3 g/dl; 12.6 g/dl; 12.8 g/dl; 12.6 g/dl (p=0.732).Median values of uterus lengths measured in pathology specimen were 9 cm (5.5-16); 9cm; 9cm(4-15); 9.5 cm (4-12), and there was no statistical difference between the groups (p=0.837). The general characteristics of the patients between groups are summarized in The operation indications of our patients are similar, and the distribution of operation indications is summarized in Considering the operation times in all groups, the 1st Group was 180 minutes (98-349). Group-2 159 minutes (96-564); 3rd Group 178 min (141-540); Fourth Group-189 (115-453) minutes; the group with the shortest operation time was the CF Group; the difference was statistically significant (P=0.015).When we look at the pre-op/ post-op hemoglobin change to evaluate absolute blood loss more accurately, although blood loss seems to be higher in the 2nd group, no statistically significant difference was observed ; 2. Group 1.9 (0.2-5.4) g/dl; 3.Group 1.4 (0.2-4.3) g/dl; 4. Group 1.5 (0.1-4.5) g/dl (P=0.094). The length of hospital stay time were similar in all groups; the average was two days in all groups (p=0.282).When the development of per-op complications in all groups was also examined, 6.5% (n=8) in Group-1; 8.6% (n=6) in Group-2; 0% in Group-3 (n=0); 13% (n=6) in Group-4 (p=0.281) but It was observed that there was no statistically significant difference. The comparison of surgical outcomes of the patients between groups is summarized in This study shows that the operation time is shorter for the CF uterine manipulator in patients undergoing LH. There are many studies on the use of manipulators in laparoscopic hysterectomy. There are few data in the literature comparing different types of uterine manipulators designed to facilitate TLH in terms of their clinical benefits, efficacy, and safety. However, according to our search on PubMed and Scholar Google, no study compares the use of Clermont-Ferrand (CF) and RUMI manipulators. It is perhaps the first study. Although it was not statistically significant in our study, the operation time was longer in the RUMI manipulator group. In a comparative study of the RUMI manipulator with the V Care® manipulator, the operation time  was significantly higher in the RUMI manipulator group.12In the study of Aslan et al., which compared three manipulators, CF, RUMI, and V Care®, in terms of operation times, no statistically significant difference was found (90 (50–180) minutes. in CF vs. 90 (50–180) minutes. in RUMI vs. 80 50–130) minutes. in V Care®, p =0 .51).0 minutesIn the study of Yavuzcan et al.From this point of view, although the surgeon’s experience is an essential parameter during the operation, the CF manipulator seems to make the surgeon’s work more straightforward than the RUMI manipulator.On the other hand, although absolute blood loss seems to be a little more in the CF group, statistically significant results are needed to reach a definitive interpretation. Similar to our study, in a survey that compared three manipulators, Clermont-Ferrand, VCare, and RUMI, the group with the highest blood loss was CF.13The lowest absolute hemoglobin change among the groups was 1.4 g/dl (0.2-4.3) in the Curette-buffer group. Similarly, in the report of Dimitrios et al., in 1023 cases where a uterine manipulator was not used, the estimated blood loss was as low as 59 mL (20-260 mL).16Five cases (0.5%) had vaginal cuff detachment in the long term, and one patient had vaginal cuff hematoma.18It is already known that; laparoscopic hysterectomy is more advantageous for postoperative infection ratio and analgesia needs.On the other hand, there was no ureter injury in all groups of our study. When we look at the literature, the ureteral injury incidence reported in patients who underwent total laparoscopic hysterectomy is 0.5-1%.There are some limitations because our study’s data was obtained retrospectively; like operation, time is include uterine manipulator insertion period and anesthesia premedication period. On the other hand, uterine manipulator insertion time duration can also be a negative parameter for choosing a uterine manipulator.In our study, the choice of uterine manipulator did not affect the surgical results except for the duration of the operation. Clermont-Ferrand (CF) seems to be more advantageous compared to RUMI and the Curette-buffer group in terms of facilitating the surgeon’s work only in terms of operation time. On the other hand, although it is not statistically significant, the least blood loss group is the curette-buffer group. Commercial uterine manipulators do not seem to contribute much to patient morbidity. However, a statistically significant difference can be found in large patient series. As a result, the personalization of uterine manipulators according to the needs of the surgery and the easiness of use of the surgeon should be at the forefront.MS: conception and design, acquisition of data, analysis, and interpretation of data; drafting the article, final approval of the version to be published.HSS: Contributions to conception and design, data acquisition, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be published.


The ratio between DAD and AAD is a parameter worthy of analysis as a tool to stratify the risk of dissection.(1) Background: There is a need for a novel surrogate marker to ease decision making when facing ascending aortic dilatation. In this article, we study the ratio between ascending and descending aorta diameters as a potential one. (2) Methods: Retrospective observational cohort study, including all the patients who underwent surgery for acute type A aorta dissection (aTAAD) between January 2014 and September 2020 at our center. A total of 50 patients were included. Clinical and demographic data were collected. The anatomical measurements were made including orthogonal maximal diameters of the ascending and descending aorta, post-dissection whole circumference length (post-wCL), post-dissection true lumen circumference length (post-tCL), and surface and sphericity indices of the ascending and descending aorta. Pre-dissection ascending aorta diameter (pre-AAD) and pre-dissection descending aorta diameter (pre-DAD) were calculated as well as the ratio between them and compared with reference values. (3) Results: Of the pre-AAD patients, 96% had smaller than the recommended 55 mm. The ratio between the descending and ascending aorta pre-dissection diameters was significantly smaller compared to the reference value (0.657 ± 0.125 versus 0.745 ± 0.016 with a mean difference of −0.088 and a  Acute ascending aortic type A dissection (aTAAD) is a life-threatening condition with an increasing annual incidence of 3–6 cases/100,000, compared to the 2.9/100,000 cases in the 2000s , which was obtained with the T. Yamauchi et al. equation .. Once the maximal pre-dissected AAD and DAD were obtained, the ratio between them was computed.The pre-dissected AAD and DAD obtained were compared, with normal aorta diameters, defined by gender, age and BSA, as reported by Wolak et al. in their 2008 study .They assessed the normal limits of ascending and descending aortic dimensions via non-contrast gated cardiac CT, adjusted to age, gender and BSA, in a large, low-risk population of subjects undergoing coronary artery calcium scanning.Additionally, the ratio computed between pre-dissected DAD and AAD was compared individually according to gender, sex, and BSA to a reference ratio extrapolated from the Wolak et al. database .The data analysis was performed by the epidemiology and statistical department at our center using the statistical software SPSS version 25. Parametric tests were used for comparison between the observed and the reference diameter and ratio values.2. Arterial hypertension was present in 62% (31) of the patients. Aortic valve insufficiency was identified via TTE or TOE in 38% (19) of patients. Smoking and alcohol drinking habits were observed in 32% (16) and 34% (17) of the sample, respectively. The total mortality (30-days) was 16% (8) with a 10% (5) intraoperative mortality . Twenty percent of the patients did not present an extension of the dissection into the descending aorta. The mean calculated pre-DAD was 26.41 ± 5.32 mm, not showing a statistically significant difference with the reference DAD value  (Ninety-six percent (48) of the patients had a pre-AAD smaller than the current 55 mm cut-off value. The mean calculated pre-AAD was 40.87 ± 7.95 mm compared to a gender and BSA matched general population reference value of 34.24 ± 1.61 (= 0.415) . The sphp < 0.001), showing a significantly lower average compared with the reference values. The ascending aorta diameter was, on average, 1.5 times larger than the descending aorta diameter, as illustrated in The ratio of the computed pre-ADD and pre-DAD was 0.66 ± 0.13. The reference ratio from a population-based study  was 0.74Preventing aTAAD is still a major challenge. As the literature ,7 and ouAlternative risk stratification tools and clinical surrogate markers have been proposed in the past few years such as, for example, the ascending aorta surface or the elongation of the ascending aorta ,13,14.2/m obtained using new three-dimensional technology. On another hand, Krüger et al. [Masri, A. et al. ,15 descrr et al. ,16,17 for et al. . This idr et al.  in a morIt is widely acknowledged that the aortic diameter has an important interindividual variability, and hence a more patient-tailored approach is mandatory to assess the individual risk of dissection. A retrospective review of the CT scans of the patients we operated on for aTAAD shows that most of the patients presented with overall AAD below the recommended cut-off value, but also had strikingly large discrepancies between the AAD and the DAD.The aorta remodels with growth, but the correlation between the ascending and descending aorta should remain stable. We therefore hypothesize that an AAD remarkably larger than the DAD translates to an abnormal remodeling and might increase the risk of dissection.Our results are based on a sample of patients with remodeled aortas due to acute dissection, and hence the diameter observed in a post-dissection aorta does not correspond to the pre-dissection diameter. As Nakashima  describeDifferent authors have tried to estimate the pre-dissection diameter. Mansour et al.  concludep-value < 0.001) between the pre-dissection DAA/AAD and AAD/DAD ratios in our patients and the reference ratio from a population-based study. The main ratio of AAD/DAD that we obtained (1.58 ± 0.33) implies an ascending aorta diameter 1.5 times greater than the descending aorta diameter compared to the calculated reference value from the Wolak et al. database (1.34 ± 0.03).Finally, based on the calculated-before-dissection AAD and DAA, there is a significant difference , our results are based on a small, mono-centric patient sample (n = 50), with observed diameters from already dissected ascending aortas. Furthermore, they were compared to a calculated reference value extrapolated from a population with normal aorta diameters instead of a population with aneurysmatic aortas, which would be a more interesting control.Despite showing a statistically significant difference between the ratios (Moreover, looking at the plot-chart , there iThe ascending aorta maximal diameter is an insufficient standalone criterion to assess dissection risk. Due to the limitations of our study, we cannot confirm the ratio between ascending and descending aorta diameters as an independent risk factor for dissection. That being said, a cut-off value of an ascending aortic diameter of 1.5 times the descending aortic diameter might be a patient-tailored surrogate marker for increased dissection risk. RADAR combined with other parameters such as elongation of the aorta, body surface indexed diameters, ulceration, and presence of a bicuspid valve might highly enhance guidance for dilated ascending aortas with diameters of less than 55 mm as a new risk stratification score. Further clinical investigation needs to be undertaken to confirm our results.


The therapy concepts that target several members of krüppel like factor (KLF) family have been achieved in breast cancer (BC). However, the role of KLF11 in BC remains unclear. This study explored the prognostic significance of KLF11 in BC patients and investigated its functional roles in this malignancy.Immunohistochemistry (IHC) staining of KLF11 in 298 patients’ samples was performed to determine the prognostic role of the KLF11. Then the protein level was correlated to clinicopathological characteristics and survival outcomes. Afterward, the function of KLF11 was explored in vitro with siRNA-mediated loss-of-function of cell viability, proliferation, and apoptosis.From the cohort study, we found that the expression of KLF11 was positively associated with highly proliferative BC of BC. Furthermore, prognostic analysis demonstrated that KLF11 was an independent negative factor for disease-free survival (DFS) and distant-metastasis-free survival (DMFS) of BC. The KLF11-related prognostic model for DFS and DMFS showed high accuracy in predicting the 3-,5- and 10 -year survival probability of BC patients. Additionally, the knockdown of KLF11 inhibited cell viability and proliferation, as well as induced cell apoptosis in MCF7 and MDA-MB-231 cells, while only inhibited cell viability and induced cell apoptosis in SK-BR-3 cells.Our study indicated that targeting KLF11 is an interesting therapeutic concept and further research could lead to a new therapeutic improvement in BC, especially in highly aggressive molecular subtypes. Breast cancer (BC) is a heterogeneous disease characterized by diverse molecular subtypes , 2. BC sKrüppel like factors (KLFs) are transcriptional factors that belong to zinc finger family. Aberrant expression of KLFs is observed in BC . They reHere, we explored the prognostic role of the KLF11 by performing immunohistochemistry (IHC) staining of KLF11 in 298 samples of BC patients, followed by clinicopathological correlation and survival analysis to assess the clinical significance of KLF11. In addition, to reveal its regulation in cellular function, we explored the siRNA-mediated loss-of-function of KLF11 by performing cell viability, cell proliferation, and cell apoptosis assays in luminal, HER2-amplified subtype, and TNBC cell lines, respectively.n = 306). Patients with primary distant metastases (n = 6) and patients only with ductal carcinoma in situ (DCIS) (n = 2) were excluded. In total, 298 patients were included. The Institute of Pathology assigned the tumor grading (according to the Elston-Ellis system). Patient data regarding patient age, ER status, PR status, HER2-amplification, metastasis, local recurrence, progression, and survival were retrieved from the Munich Cancer Registry. The surrogate molecular subtypes were defined: Luminal A-like , Luminal B-like , TNBC , HER2 amplified Luminal-like  and HER2 amplified non-Luminal-like  [In this study, 320 consecutive patients who underwent surgery for BC from 2000 to 2002 at the Department of Obstetrics and Gynecology, Ludwig-Maximillian's-University of Munich, Germany. In the further analyses, only cases with a diagnosis of sporadic BC and without family history for BC were included  . SurvivaThis study has been approved by the Ethics Committee of the Ludwig-Maximilian-University Munich . The BC specimens were obtained in clinically indicated surgeries. All diagnostic procedures were completed when the current study was performed, and the patients' data were anonymized. The ethical principles adopted in the Declaration of Helsinki 1975 have been respected. As per declaration of our ethics committee, no written informed consent of the participants or permission to publish is needed given the circumstances described above. Researchers were blinded from patient data during experimental and statistical analysis.IHC was performed as previously described . BrieflyImmunoreactive score (IRS) was calculated to evaluate the IHC result of KLF11. The IRS of KLF11 was assessed by two experienced investigators independently. Receiver operating characteristic (ROC) analysis was used to define optimal cutoff points . The IRSForest plots were used to display the prognostic role of KLF11 in BC subgroups grouped by clinicopathological parameters. The R package "ggplot2" was used to plot the analyzed univariate cox results. The R scripts were performed in R programmer version 3.6.3.Nomograms were modeled and developed using R packages "survival" and "rms". The concordance index (c-index) represents the nomogram capability of discrimination. The closer c-index is to 1.0, the higher the discriminative performance level . The preMCF7 , MDA-MB-231 , and SK-BR-3 (Nr.ACC736 DSMZ) were used to explore the functional role of KLF11. The cell lines were cultured in RPMI 1640  supplemented with 10% fetal bovine serum . No antibiotics or antimycotics were added. All cells were incubated in 5% CO2 at 37 °C. In subsequent experiments, only cells detected to be free of mycoplasma infection were used. Neubauer cell chambers were used to count cells.KLF11-S1: CACGTAGATAACCGAGAGAAT , KLF11-S2: AGGAAGCGGCATGACAGCGAA  and KLF11-S3: TTGCCGGAAGACCTACTTCAA . After 48 h, BC cell lines were harvested for protein or RNA extraction and detection or for further cell functional experiments.Firstly, BC cell lines were pre-seeded in six-well plates. siRNA-transfection was performed when the cell density reached approximately 60%. The transfection procedure was performed according to the manufacturer's protocol of the Lipofectamine RNAiMAX reagent . BC cell lines were transfected with AllStars Negative Control (NC) siRNA , and two independent siRNAs target KLF11: KLF11 from mRNA level with FastStart Essential DNA Probes Master kit  and gene-specific primers using the LightCycler Nano (Roche). ACTB (β-actin) was used as the reference gene. KLF11 primers  and ACTB primers  were used.RNA was extracted following the manual of RNeasy Mini Kit . Subsequent reverse transcription was carried out with Biozym cDNA Synthesis Kit  and implemented as the manual. Real-time PCR (rtPCR) was performed to validate the knockdown of 450 and OD595 was measured. Three replicates were performed with each cell line. To guarantee the reliability, we repeated the experiment at least three times.The colorimetric cell-based KLF11 ELISA Kit  was used to validate the siRNA-mediated knockdown of KLF11 from protein levels. Firstly, the siRNA transfection for KLF11 knockdown was conducted as described above. Afterward, the measurement procedure and data normalization were performed as the manufactural’s manual. The absorbance of optical density (OD)Firstly, the siRNA transfection for KLF11 knockdown in BC cell lines was conducted as described above. After 48 h, BC cell lines were harvested for further cell functional experiments.Cell viability was evaluated using the Methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay. Harvested cells were then seeded (3500 cells/well) into three sets of 96-well plates with five replicates for each cell line and cultured in 10% FBS-containing RPMI 1640 medium for 24 h, 48 h, and 72 h, respectively. Then incubation ended at three different time points, and at each time point to each well, MTT solution  was pipetted. After removing the MTT-containing medium, dimethyl sulfoxide  was added. The absorbance of OD595 was measured.Cell proliferation rate was determined using Cell Proliferation ELISA kit . Cells were then seeded (5000 cells/well) into two sets of 96-well plates with five replicates for each cell line and cultured in10% FBS-containing RPMI 1640 medium for 24 h and 48 h, respectively. Then the entire procedure was performed according to the manual. Briefly, when the incubation ended at two different time points, supplemented each time point to each well with BrdU (20 μl/well). The absorbance of OD450 was measured.Cell apoptosis was detected using the Cell Death Detection ELISA kit . BC cell lines were then harvested and prepared as sample lyses for further detection. The assay was performed according to the manufacturer’s instructions. The absorbance of OD405 was measured.All the absorbance was measured using an Elx800 universal Microplate Reader and analyzed using Gene 5 software. To guarantee the reliability, all the experiment was repeated at least three times.U test were used for two-group comparisons. One-way ANOVA and Kruskal–Wallis test were used for multiple-group comparisons. Dunn's test was implemented for pairwise comparisons within the multiple groups. In addition, Chi-Square Test was performed for the comparison of categorical variables. Kaplan–Meier (KM) survival analysis was performed with Log-rank test. Univariate and multivariate Cox regression analyses were also performed for the survival analysis with a hazard ratio (HR) and a 95% confidence interval (CI). The proportional hazards assumption test was performed for each variable in all cox models using the Schoenfeld statistical test. All reported p values are two-sided. P-values < 0.05 were considered statistically significant.IBM SPSS (version 26) and Graphpad Prism 8.1 was used for statistical analysis and illustrations. Data was first subjected to normality and equal variances test. Student's t, Welch's, and Mann–Whitney P = 0.002, Fig. P = 0.027, Fig. P = 0.016, Fig. KLF11 was successfully stained in 292/298 samples . The expression of KLF11 was higher in more proliferative BC that with the expression of Ki-67 > 14%  cases were categorized as “KLF11-high” subgroup, while 90 cases (30.8%) were characterized as “KLF11-low” subgroup. We found that the BC patients with KLF11-high expression were more in non-luminal-A than in luminal A subgroup  and patients older than 50 yo . KLF11 was negatively associated with DFS both in BC patients with the appearance of unifocal tumors  and multifocal/multicentric tumors . However, a higher expression of KLF11 led to shorter DFS of the patients only with histological type of invasive ductal carcinoma and/or invasive lobular carcinoma , of Luminal A-like BC , of patients with G1 or G2 BC , of patients without lymphatic metastasis , of patients with tumor size ≤ 2 cm , of patients with ER positive , of patients with PR positive  and of patients with HER2 unamplified statues  and of the BC subgroup with a low proliferation rate (Ki-67 ≤ 14%) .In addition, we explored the prognostic role of KLF11 in subgroups that grouped by the clinicopathological characteristics. Concerning OS, no prognostic significance of KLF11 was found , which was consistent with the survival analysis across overall-BC cohort. Interestingly, the subgroup survival analysis of DFS  showed that higher expression of KLF11 led to an inferior DFS both in patients younger than 50 years old (yo) , of patients without lymphatic metastasis , of patients with tumor size ≤ 2 cm , of patients with ER positive , of patients with PR positive  and of patients with HER2 unamplified statues .Moreover, regarding the DMFS  subgroup survival analysis across clinicopathological subgroups, KLF11 was negatively correlated to DMFS only of the BC patients with histological type of invasive ductal carcinoma and/or invasive lobular carcinoma , of patients with histological type of invasive ductal carcinoma and/or invasive lobular carcinoma , of Luminal A-like BC , of patients with the appearance of unifocal tumors , of patients without lymphatic metastasis , of patients with tumor size ≤ 2 cm , of patients with ER positive , of patients with PR positive  and of patients with HER2 unamplified statues  and also of the BC subgroup with a low proliferation rate (Ki-67 ≤ 14%) .Furthermore, the subgroup survival analysis of LRFS  showed that high KLF11 expression correlated to impaired LRFS only of patients that aged older than 50 yo , grading , tumor size  and lymph node status  were significantly associated with DFS across the BC cohort (Table p = 0.011), grading  and tumor size  were independent factors for poor DFS , molecular subtype , grading , tumor size  and lymph node status  were significantly associated with DMFS in BC (Table p = 0.046), grading , and tumor size  were independent factors for poor DMFS  revealed by the multivariate cox regression analyses, we developed two prognostic model displayed by nomograms in predicting DFS and DMFS for BC patients Fig. . In the In summary, based on the multivariate cox regression analysis of the BC cohort, the constructed KLF11-related prognostic models for DFS and DMFS have a high accuracy in predicting the 3-,5- and 10 -year survival probability of BC patients.Taken together all the results from the cohort study, we could speculate that KLF11 might act as an oncogene in BC. To investigate the functional role of KLF11 in BC, we performed siRNA-mediated loss-of-function of KLF11 with cell viability, cell proliferation, and cell apoptosis assays in ER-positive luminal type (MCF7), HER2 amplified type (SK-BR-3), and TNBC (MDA-MB-231) cell lines. The successful knockdown was confirmed at the mRNA level by rtPCR  and at the protein level by colorimetric cell-based KLF11 ELISA .KLF11-siRNAs  to further strengthen the credibility of the data for these three cell lines . With the KLF11-S3 obtaining similar observation, these results indicated that KLF11 could promote BC cell growth, especially of TNBC. Moreover, the BrdU assays showed inhibition of proliferation after the knockdown of KLF11 in MCF7  on MCF7, SK-BR-3, and MDA-MB-232 cell lines was same, the induced extent of the cell apoptosis by different sequence of KLF11-siRNAs in different molecular subtype BC cell lines was shown to be different. This might be dependent on the different underlying mechanism of KLF11 involved in apoptosis in different subtypes of BC cell lines, which we also curious about. It is worth to noting that KLF transcription factor family is characterized by the possibility of performing different functions in different molecular subtypes of BC . It is nInterestingly, it has been demonstrated previously that miR-30d promotes BC cell growth, depending on the low expression of KLF11 . This inHowever, there are limitations. Our BC cohort is 20 years old (primary diagnosis 2000–2002). The advantage of an old patient cohort in terms of very long follow-up data is, in this case, also a disadvantage, as data on treatment cannot be obtained anymore. In addition, at that time, neoadjuvant chemotherapy therapies were not applied regularly in our clinic. However, the advantage of our data is that no patient in our cohort had undergone any prior treatment before surgery was performed. Regarding adjuvant therapy, even if we do not display it specifically, it is assumed to be the same in the two groups now sub-divided by KLF11-high/-low. Additionally, KLF11 was an independent prognostic factor in our cohort, which suggests that treatment  should not cause any bias in our data. Since neoadjuvant chemotherapy has become common recently, this factor must be regarded in any research using more recent patient samples.In conclusion, our study indicated that KLF11 might be a potential screening marker for patients with relatively short survival and at risk of developing a more aggressive type of in less aggressive molecular subtypes of BC. Most importantly, our study suggested that targeting KLF11 is an interesting therapeutic concept and further research could lead to a new therapeutic improvement in BC.


This study aimed to find out the characteristics in relation to tumor recurrence in diffused-tenosynovial giant cell tumor of temporomandibular joint and to develop and validate the prognostic model for personalized prediction.From April 2009 to January 2021, patients with diffused-tenosynovial giant cell tumor of temporomandibular joint at a single center were included in this study. The clinical features and local recurrence-free survival were assessed through the expression of the Ki-67 index and colony-stimulating factor 1 receptor expression. Both univariate and multivariate analyses were performed on the prognostic factors for local recurrence-free survival. An independent predictor nomogram and pertinent tumor characteristics were included.The retrospective study enrolling seventy eligible patients at the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. During the follow-up time, eleven patients suffered tumor recurrence. Age was an independent risk factor for local recurrence-free survival (P = 0.032). The Ki-67 index varied significantly in different sites (P = 0.034) and tumor volume (P = 0.017). Multivariate logistic regression was used to develop the prediction model using both statistical significance and prognostic indicators. The C-index of the nomogram based on age, site, Ki-67, and colony-stimulating factor 1 receptor was 0.833. These variates provided good predicted accuracy for a nomogram on local recurrence-free survival. Diffused-tenosynovial giant cell tumor from the temporomandibular joint is extremely uncommon, and certain clinical traits are linked to the tumor proliferation index.We identified the risk indicators and developed a nomogram in this study to forecast the likelihood of local recurrence-free survival in patients with diffused-tenosynovial giant cell tumor from temporomandibular joint.The online version contains supplementary material available at 10.1186/s12885-023-11587-7. TSGCT iTenosynovial giant cell tumors are benign, proliferative, and destructive lesions of the synovium that originate in joints, tendon sheaths, and bursae, according to the World Health Organization’s (WHO) classification of soft tissue and bone cancers . AccordiThis study was approved by the Ethical Committee of Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine  (SH9H-2022-T298-1). Informed consent for participating in the clinical study was signed by all involved patients. From April 2009 to Jan 2021, a total of 70 cases of D-TSGCT in the TMJ area were diagnosed and treated in our hospital, their paraffin specimens and clinical characteristics such as sex, age, site, symptom, size, bone destruction, surgery complication and follow-up time were collected  and the percentage of positive cells (PP), that is, IRS = SI*PP. The positive rate score is calculated as the percentage of the number of positive cells: 0 = negative, < 5%; 1 = weakly positive, 5%~24%; 2 = moderately positive, 25%~49%; 3 = strongly positive, 50%~74%; 4 = super positive, ≥ 75%; grade of staining intensity: 0 = none; 1 = weak positive; 2 = positive; 3 = strong positive .An immunofluorescence test was used to localize the Ki-67 and CSF-1R protein expression. Image J was applied to detect the fluorescence intensity of each protein . Three fSPSS statistical software version 23.0 (IBM Corp) and R software version 6.3  was used for all statistical analyses. Wilcoxon x2 test and student t test was used. local recurrence-free survival (LRFS) is defined as the time from the first treatment of the tumor to the local tumor recurrence, and the recurrence is defined as the tumor after the complete resection of the tumor through imaging or clinical examination. LRFS rates were analyzed using the Kaplan-Meier method, and inter-subgroup differences were examined by the log-rank test. The best cut-off value of Ki-67 and CSF1R expression level was determined based on the receiver operating characteristic (ROC) curve to find the boundary value and divide the variables into binary variables. P values were 2-sided and were considered statistically significant if less than 0.05. In order to build the nomogram for the prediction of the recurrence, a statistical significance level of 0.1 in cox univariate analysis was selected as a risk factor. We aimed to establish a model for the individualized estimation of LRFS in D-TSGCT. Nomograms to estimate 3-year and 5-year LRFS were generated based on the risk factors established by multivariate analysis and immunohistochemistry indicators with R version 6.3. The performance of the nomogram to discriminate and calibrate depended on the Harrell concordance index (C index) and calibration curve. The value of the C index ranged from 0.5 to 1.0 and a value of that at least 0.7 indicated that the model has a good discriminating ability. Decision curve analysis (DCA) was employed to examine the clinical net benefit of a predictive model by the rmda package in R. It is an R package for regularized classification and feature selection methods .Between April 2009 to Jan 2021, a total of 70 patients with D-TSGCT in the TMJ area underwent radical surgery in our hospital. A summary of basic demography is presented in Table All the patients received surgical treatment. Twenty-four patients (34.3%) had post-operative complications. Facial paralysis (14.3%), limited mouth opening (5.7%), malocclusion (4.3%), and hearing loss (4.3%) were the four main post-operative complications. The median follow-up time was 51.3 months (ranging from 11.6 ~ 141.4 months). Patients younger than 46 years (the median age) had an average follow-up of 53.83 months (median 41.9 months), while patients 46 years or older had a mean follow-up of 54.69 months (median 50.8 months). No one received adjuvant treatment after surgery. A total of eleven patients showed recurrence and the average recurrence time was 36.3 months. All of the patients were still alive at the last follow-up date, and only one patient underwent salvage surgery. Complete surgical resection with negative margins was achieved in all patients except one (patient 36), who underwent re-excision to obtain negative margins after initial positive margins were identified upon pathological analysis. Detailed pathological margin status for each patient is provided in Supplementary Table 1.The surface of the tumor was either dark red, reddish brown, or gray with or without cystic alteration Fig. B. The leAccording to the ROC curve, at a cut-off value of 2%, the intensity of the Ki-67 gene was divided into two groups: 32 samples with low expression, which accounted for 45.7% (32/70), and 38 samples with high expression, which accounted for 54.3% (38/70). Figure The positive expression of Ki-67 in patients with supra-articular cavity was significantly higher than that in patients with a subarticular cavity, and there was a significant difference in the expression of Ki-67 between the two sites . In patients with different tumor volumes (diameter ≥ 2.5 cm vs. diameter < 2.5 cm), there was a substantially varied expression of Ki-67 (P = 0.017). Patients with tumors that were less than 2.5 cm in diameter had significantly higher levels of positive Ki-67 expression than patients whose tumors were larger than 2.5 cm.CSF-1R expression intensity was separated at the cut-off value of 3% into two groups: 16 samples with low expression, accounting for 22.9% (16/70), and 38 samples with high expression, accounting for 77.1% (54/70). The LRFS between different expressions of CSF1R was shown in Fig. Mononuclear histiocytes, multinucleated giant cells, and big synovial monocytes make up the majority of the tumor structure. Ki-67 was primarily expressed in the nucleus of monocytes. The cytoplasm and cell membrane surfaces of monocytes and macrophages were the primary sites of CSF-1R expression. The different expressions of Ki-67 and CSF-1R with immunohistochemical staining from TMJ D-TSGCT samples were presented in Fig. Age, site, Ki-67 index, and CSF-1R variables were included in the model based on the findings of the Cox regression and associated clinical values  versus the older group (50.8 months). Age remained a significant predictor of recurrence on multivariate analysis, indicating it represents an intrinsic biological driver of recurrent disease, rather than just a reflection of observation time. Younger age may confer inherent tumor traits leading to increased proliferative/invasive potential and recurrent growth. The underlying biological mechanisms for this warrant further investigation but are beyond the scope of this clinical outcomes study. Even though D-TSGCT was a benign tumor with an invasion of proliferative and inflammatory cells, roughly 87.1% of tumors showed bone damage. Previous studies reported that about 30%~50% of cases had skull base invasion. The 68.6% rate of middle cranial fossa invasion in my cohort closely matches the 66% rate found in the systematic review by Kanbour et al. This aligns with their large case series and confirms the high propensity for intracranial extension in TMJ D-TSGCT . The skuOur results also showed that the expression of Ki-67 from the supra-articular cavity is higher than the expression of Ki-67 in sub-articular space lesions (P = 0.032). The supra-articular cavity tumor was larger and more likely to recur (79.2%). In the study of Wang et al., it was found that the average Ki-67 index of relapsed cases was significantly higher than that of non-relapsed cases (P < 0.05). Adjuvant radiotherapy is used to control local tumor remnants or recurrent tumors, and it is believed that the Ki-67 index has predictive significance for recurrence . Relapse24 As an important tyrosine kinase transmembrane receptor on the surface of TAM cells, CSF-1R regulates the development, morphology, survival and function of TAM. Although the expression of CSF-1R was not significantly related to a variety of clinical features in D-TSGCT, there was a tendency that expression of CSF-1R was consistent with the expression of Ki-67. Patients with higher CSF-1R expression were more likely to recur. The activation of the CSF-1/CSF-1R pathway could contribute to the conversion of TAMs from M1 to M2 phenotype [Specific gene translocations, which led to the recruitment of CSF-1R-expressing cells such as monocytes, macrophages, and some tumor cells, were the primary cause of TSGCT. It was reported that the expression of CSF-1R was associated with poor prognosis in certain cancers . Tumor ahenotype , 26. We As was mentioned before, D-TSGCT originated from TMJ and had specific clinical features. D-TSGCT was classified as a borderline tumor by the ICD WHO and was vulnerable to recurrence following excision. As a result, this nomogram performed well in terms of recurrence prediction when using the C-index, calibration curve, and DCA based on the TRIPOD statement standard. Our study suggests that pre-operative factors, including age, tumor growth invasion, and higher Ki-67 expression level are associated with tumor recurrence. A recurrence rate of 21% within the first 5 years following treatments was seen in a meta-analysis of D-TSGCT in foot and ankle lesions . A higheOur study has some limitations. Firstly, our nomogram is based on data from a single institution. It is necessary to have external validation. Secondly, all the patients underwent surgical resection as a treatment method, more treatment could be applied in the patients with a high risk of recurrence. Finally, the number of patients was small because of the scarcity, and further studies are needed to optimize a better prediction model.D-TSGCT of TMJ is accompanied by adjacent bone destruction. Tumors from the supra-articular cavity are more invasive and proliferative based on Ki-67 expression and clinical features. The first nomogram for predicting LRFS in patients with D-TSGCT was created in our study, this nomogram provides accurate calibration and discrimination.Below is the link to the electronic supplementary material.Supplementary Material 1


S) usually requires a relatively large electric field (E) excitation, resulting in a low inverse piezoelectric coefficient d33* (S/E). Moreover, the hysteresis and fatigue of strain in these materials have also been bottlenecks impeding the applications. The current common regulation method is chemical modification, which mainly focuses on forming a solid solution near the morphotropic phase boundary (MPB) by adjusting the phase transition temperature of the materials, such as BNT-BaTiO3, BNT-Bi0.5K0.5TiO3, etc., to obtain a large strain. Additionally, the strain regulation based on the defects introduced by the acceptor, donor, or equivalent dopant or the nonstoichiometry has proven effective, but its underlying mechanism is still ambiguous. In this paper, we review the generation of strain and then discuss it from the domain, volume, and boundary effect perspectives to understand the defect dipole behavior. The asymmetric effect caused by the coupling between defect dipole polarization and ferroelectric spontaneous polarization is expounded. Moreover, the defect effect on the conductive and fatigue properties of BNT-based solid solutions is described, which will affect the strain characteristics. The optimization approach is appropriately evaluated while there are still challenges in the full understanding of the defect dipoles and their strain output, in which further efforts are needed to achieve new breakthroughs in atomic-level insight.Bismuth sodium titanate (BNT)-based, lead-free piezoelectric materials have been extensively studied due to their excellent strain characteristics and environmental friendliness. In BNTs, the large strain ( The contradiction is raised by balancing the large strain and low hysteresis, as shown in 33* in the high strain side of the asymmetric bipolar strain curves has recently been reported in several works where the defect dipole plays a critical role associated with either relatively large or moderate hysteresis.Piezoelectric material is an important functional material that constitutes the core component of electronic devices widely employed in new technology fields, including actuators, sensors, and transducers, since it can realize the conversion of electrical energy and mechanical energy. Lead-based piezoelectric materials, represented by PbZr−xTixO3  . Monitorry (MPB) . There ary (MPB) . The elery (MPB) . BNTs wi3+ and Na+ coexist in the A-site at the vertex of the unit cell [a−a−a− and in-phase tilt a0a0c+) are accompanied, and the average structure and local structure are changed accordingly. When the temperature continues to decrease below the relaxation-ferroelectric phase transition temperature (TF–R), the material transforms into the nonergodic relaxation phase (NR). At this time, the nano-domain appears in the system, and the electric field is large enough to cause the phase transition of the BNT-based material from the NR to the FE, also accompanied by the structure change above [BNT exhibits a complex perovskite structure in which Binit cell . Its disnit cell . Althougge above . HoweverS/E smaller than that of KNN and BT-based materials (>1000 pm/V), while the maximum unipolar strains of these two materials rarely exceed 0.4% [S/E of BNT-based materials needs to be further ameliorated, which should be considered under the condition of a reduced applied electric field. On the other hand, the large hysteresis ΔS/Smax > 50%  [S-E curves. Furthermore, the fatigue properties of BNT-based materials should also be optimized in an effort to ensure the reliability of the application [Generally, the large strain of BNT-based materials is triggered by a large electric field , which meed 0.4% ,39. The c field)  and infec field) ,42 are tTd [0.5(Na0.75K0.25)0.5TiO3-BiAlO3 ferroelectric/relaxor ceramics can enhance the strain properties [Currently, the common strategy to synthesize materials with excellent strain properties, including ferroelectric phase/relaxation phase composites, that is, ferroelectric phase/relaxation phase BNT-based materials, is to form 0–3 type composites to reduce the strain hysteresis of BNT  or polarTd . For insoperties . Or by aoperties . Moreoveoperties . The intS-E loops induced by the coupling of defect dipoles and spontaneous polarization are demonstrated. The strain properties of BNT-based solid solutions under the action of defect dipoles are compiled. We summarize the recent research and the primary issues with defect dipoles, and future work is prospected.Most of the modified systems focus on the formation of solid solutions at MPB to regulate the temperature of phase transition between the ER and the FE of the material to obtain large strain , and onlS-E curves, which is advantageous for practical applications [S-E loops, giving rise to more complicated strain [The interaction between the polarization intensity and consequent strain output displays a fascinating research hotspot when applying an electric field to ferroelectric materials. This strain is primarily due to the intrinsic contributions from the inverse piezoelectric effect and electrostriction, which are brought about by the ion displacement from its equilibrium position, resulting in negligible hysteresis of ications . The extications ,50. Thesd strain .0.5Na0.5TiO3-0.06BaTiO3-0.03(K0.5Na0.5)NbO3 (0.91BNT-0.06BT-0.03KNN) ceramics under an electric field of 80 kV/cm. The strain was considered to stem from the antiferroelectric-ferroelectric phase transition because the material showed double hysteresis loop characteristics [xKNN ceramics shows that the repeatable large strain nature is a recoverable feature of the transition from non-polarized to ferroelectric phase under the application of electric fields [The preliminary study of the typical ferroelectric material BNT focuses on the large strain of approximately 0.45% measured in 0.91Bieristics ,53. By seristics . In Figuc fields .0.5(Na0.84K0.16)1/2)0.96Sr0.04)(Ti0.975Nb0.025)O3 (BNT-2.5Nb) ceramics, and they obtained the same conclusion, as illustrated in Kling et al. studied the non-polarized phase utilized in in-situ TEM of 0.91BNT-0.06BT-0.03KNN ceramics. As displayed in Sr. Furthermore, an electric field is applied to poled specimens, inducing a piezoelectric strain Se. In contrast, the specimen with the ferroelectric-nonpolar phase boundary exhibits PNRs in the nonpolar matrix in A schematic illustration of electric field-induced nonpolar pseudocubic to polar anisotropic symmetry has been advanced by Lee et al. . As exhiIn perovskite structures, the vacancy will be frequently created during the synthesis and substitution processes and has an important effect on the “hardening”, “softening”, aging, fatigue, and ionic conductivity of the materials ,62,63. FThe effect of defect dipoles can be divided into three levels: volume effect, domain effect, and grain boundary effect, as exhibited in + [3+ [Domain wall pinning and morphological changes may occur under the action of the defect dipole . The sta+  or exces+ [3+  in nonst0.5Bi0.5)TiO3-0.14(K0.5Na0.5)TiO3-0.07BaTiO3 (BNBK79) ceramics [S-E and P-E curves in 0.5Na0.5TiO3–(Sr0.7Bi0.2□0.1)TiO3 (BNT-SBT) system by Xu et al. to form the 0.5Na0.5TiO3- BaTiO3 (BNT-BT) ceramics. The reduction in S-E curves may be caused by the pinning of domain walls by defect dipoles originating from acceptor doping [Qin et al. reported Mn-doped 0.79(Naceramics . The intr strain . In the r strain . Identicr doping . TherefodP) is generated during aging and aligns along the same direction as spontaneous polarization (sP). The external electric field can cause the sP to reorient, while the dP still keeps its position during such a process. Therefore, when the electric field is removed, the directional alignment of defect dipoles will serve as an internal field to generate the domain recovery force, resulting in a tight “waist” ferroelectric hysteresis loop and increased electric strain [The symmetry-consistent short-range order theory (volume effect) of defect dipoles is widely used in other perovskite ferroelectric materials ,75, i.e.c strain . PNRs arWhen Fe ions were added to BNT, Aksel et al. found the formed defect dipole aterials ,80.0.5Na0.5TiO3-Bi0.5K0.5TiO3-BaTiO3 (BNT-BKT-BT) single crystal in the tetragonal FE phase was thoroughly studied by Teranishi et al. They discovered the tight “waist” hysteresis loops and the significantly large strain (S = 0.87%) caused by the dipole composed of A-site and oxygen vacancies [A Biin S = 0.7% causedacancies .+ entering the B site in Li-substituted (Bi0.5Na0.4K0.1)0.98Ce0.02TiO3  in which the After aging under polarization, the defect dipoles in the material tend to align in the polarization direction, generating internal tension in that direction that causes the shift of the hysteresis loop and strain. In Mn-substituted lead-based materials, Du and Yan found a large strain memory effect, meaning that the difference in strain does not equal zero when the electric field is absent ,83. Sinc0.5Na0.5)0.94Ba0.06Ti0.98(Sn0.5Sb0.4□0.1)0.02O3 (BNTBT-2SS) solid solution by manipulating the defect dipole [+E) is applied, dP switches to being aligned with the polarization field after polarization. It is beneficial for the polarization rotation of the nearby PNRs [dP direction, resulting in a larger strain. Correspondingly, the transition of PNRs to ferroelectric domains is hindered by dP when an electric field is applied in the opposite direction of polarization, resulting in a small strain.Jia et al. obtained a giant asymmetric strain in . It is considered that the x0.5+(Na0.82K0.18)x0.5−3TiO3 and Biy0.5+(Na0.82K0.18)0.5TiO3, it is found that the generation of A-site vacancies will lead to the destruction of long-range ordered phases by random defect fields and make the domain switch easier [0.505(Na0.8K0.2)x0.5−TiO3-0.01SrTiO3 (BNKST (0.5−x)) ceramics and confirmed that the recoverable large strain caused by the reversible RE-FE phase transition is closely related to complex vacancy defects and local random fields [Jo et al. prepared Nb- and Fe-substituted BNT-BT-KNN ceramics and found that ic phase ,93. Howee energy . In non-h easier . Liu et m fields .Yao et al. found that in Mn-replaced A-site ions of BNT thin film, the presence of defect dipoles increased the size of PNRs. At the same time, the regulation of tolerance factors promoted the occurrence of oxygen octahedrons in-phase tilt. The phase structure of BNT itself is very sensitive to defects, and the phase structure is one of the determinants of strain characteristics. In addition to the general volume effect, domain effect, and grain boundary effect, the study of the mechanism of defect dipole behaviors in BNT materials should also consider the change of phase structure caused by the introduction of defect dipoles, including the change of average structure and local structure .According to Hiruma et al., the volatilization of Bi ions in BNT-based materials brings in the generation of polarize . This sepolarize . Li et aic field ,100. Theic field ,102, butic field ,104.4 cycles in the NR phase region [The fatigue behavior of materials is closely related to a number of variables. Domain structure, including domain wall pinning and domain morphology, phase transition, and internal bias field, significantly influences the fatigue behavior of ferroelectric materials . PZT-base region , while t3, it was found that the improvement in fatigue performance comes from the decline in defect content [S-E curve was almost unchanged, and the performance did not noticeably degrade after 105 cycles. This is because the formation of defect dipoles reduces the migration of oxygen vacancies and causes a decrease in the easily suppressed ferroelectric tetragonal phase. Additionally, the rising temperature increases the volume of a single cell, which improves the polarizability of the defect dipole and temperature stability [Using in-situ TEM, Guo et al. observed that the fatigue accompanying the increase in electric field cycles is due to the fragmentation of the domain brought about by the pinning of the defects on the domain wall. The excessive mobility of formance . In BNT- content . Ehmke e content . Shi et  of VO•• . Excelletability .These studies have demonstrated that the primary factor influencing the strain fatigue properties of the FE phase in BNT-based materials is the domain effect of material defects. There is a lack of macrodomain structure in the ER phase; thus, there is still a poor understanding of fatigue in this phase region.rS) is lower, and the maximum value (mS) is also lower. The properties of an asymmetric strain are that one side of the strain increases while the other side decreases, accompanied by a slight enhancement in both rS and mS. Heterostrain is a type of strain that is between symmetric and asymmetric. As the strain increases in the positive electric field direction and decreases in the negative electric field direction, it has a large mS and a significantly increased rS.As mentioned above, vacancies will be frequently created in the perovskite structure of oxides. Through the regulation of defect dipoles, different types of strain curves can be achieved. Based on the latest research, the strain patterns include symmetric strain, asymmetric strain, and heterostrain, which are summarized in S/E > 1000 pm/V) in Nb-substituted [Ei) formed by charged defects [Giant asymmetric strain behaviors occur frequently in recently reported piezoceramics . Liu et stituted  BNT-basestituted  and Li-dstituted . It is c defects .cE) under positive and negative electric fields (+E = −E), as shown in P-E and I-E loops would show an asymmetric phenomenon after the poling process, accompanied by different cE (+E ≠ −E), as seen in dP is oriented along or close to the sP direction throughout the aging process, the dP will generate iE parallel to the polarization direction [iE, the electric field should overcome the joint action of cE and iE to induce genesis domain switching, which will produce more +E. When the applied electric field is in the direction of iE, the domain switch can be easily performed due to the contribution of iE, which has a smaller −E. The hysteresis loop and current curve shift as a result of iE. These conclusions apply to the strain curve as well, namely that the defect dipole induces the formation of the internal bias field, which leads to the shift of the S-E curve and the asymmetric response [In the hysteresis loop and current curves, the symmetric curves displayed the same coercive field 0.5TiO3 (BNKT-SrNb)-textured ceramics with good fatigue resistance and low hysteresis [5+ ions. A large internal bias electric field was generated due to the alignment of the defect dipole along the polarization direction, resulting in asymmetric strain and a huge unipolar strain (1.6%), as seen in Moreover, the reaction templated grain growth method (RTGG) was employed to prepare oriented Sr/Nb-doped Bisteresis . The ele0.485Na0.485Sr0.03NbO3 (KNSN3) ceramics. Furthermore, the polarization and strain properties of KNSN3 remain stable during the aging process, as exhibited in In addition to BNT-based materials, the asymmetric strain properties of other piezoelectric materials can also be affected by defect dipoles. For KNN-based ceramics, Guo et al. elucidated the existence of asymmetric strain behavior when defect dipoles are introduced ,125. TEMS/E, small hysteresis, and fatigue resistance. This review provides a promising strategy for achieving giant strain, especially in the formation of asymmetry, by utilizing the defect dipole that is induced by ion substitution and process treatment. However, there are still the following issues in the defect regulation of the ceramics: (1) The determination of defect structure as well as the formation, distribution, flipping, and diffusion migration behavior of defect dipoles are still insufficient. (2) The structure and strain regulation mechanisms of defect dipoles in different phase regions are not clear. The mode of action of defects on the bulk effect of PNRs is unknown. (3) In the fatigue process of the ER phase with phase transition characteristics, the role of defects needs to be resolved. Through the defect design with different valence at the A/B sites, the defect dipole behavior, structure , and strain performance  by means of atmosphere treatment and process optimization should be further explored so as to achieve comprehensively large strain with small hysteresis and antifatigue performance in BNT-based materials. Until now, the universal conclusion that there is a lack of in-depth details and quantification has always been drawn from the previous reports. The regulation mechanisms and their dynamics in defect dipoles are still to be fully understood in both local and average structures.In this paper, the effect of defect dipole behavior on the structure and strain evolution of BNT-based piezoceramics is reviewed, including the volume effect, domain effect, and grain boundary effect. Associated with the conductive and fatigue characteristics, it is of great significance to obtain BNT-based materials with optimized strain properties such as large


Plasmodium vivax antigen PvMSP-119 to evaluate the prevalence of antibody positive subjects. A reversible catalytic model was used to assess the risk of exposure. The prevalence of anti-PvMSP-119 IgG was 12.84% [95% confidence interval (CI): 9.22%–16.47%], 13.93% (95% CI: 10.11%–17.74%), and 3.57% (95% CI: 1.40%–5.75%) in three different line-of-defense areas, which differed significantly (P < 0.0001). The prevalence of anti-PvMSP-119 IgG increased with age and no statistically significant difference was detected between the sexes. The reversible catalytic model indicated that the seropositive conversion rate and seronegative reversion rate were 0.0042, 0.0034, 0.0032 and 0.0024, 0.0004, 0.0065 in the first-, second-line-of-defense area and total areas, respectively, and the fitted value did not differ significantly from the observed value (P > 0.1). Although this study found the prevalence of antibody-positive subjects and the seroconversion rate in this post-elimination setting were lower than that in transmission setting, the population still had an exposure risk. Serological surveillance should be considered in post-elimination settings to provide valuable information with which to evaluate the risk of malaria re-establishment. China was declared malaria free in June of 2021. In the post-elimination setting, vigilant surveillance is essential to sustain malaria free status. Serological surveillance has been recognized as an efficient tool for assessing the immunity levels and exposure risk in a population. In this study, a cross-sectional serological survey was conducted in Yingjiang County, China, in August–September, 2021. The study sites were villages along the borders with Myanmar, which have no local transmission since the last indigenous case registered in 2016. A total of 923 participants from six villages were enrolled. The majority was aged > 36 years (56.12%) and 12.46% (115/923) participants had experienced malaria infection at least once. A magnetic- bead-based assay was used to test antibodies against  China launched the “National Action Plan for Malaria Elimination in China (2010–2020)” in 2010  was widely used in China during the 1980s–2000s  and the The key areas in the national malaria elimination program, which were surveyed in the last step of the program, were the border areas between China and Myanmar, mainly in Yingjiang County. The last indigenous case of malaria in China was registered in this county in April 2016. In the last stage of the elimination program, a joint cross-border malaria prevention and control project termed “3+1 Strategy”, which was initiated for establishing a buffer zone of border malaria in these areas in 2017. Here, the “+ 1” was a catchment area in Myanmar side with a length of 20.5 km and a width of 2.5 km along the boundary, where the joint work and integrated measures were implemented, including funding and technical assistance, training on early case detection and management, focus response, vector control and surveillance, and health education, etc. The “3” referred to establishing three lines of defense in Yingjiang County where undertook national 1–3–7 approach to accelerate the process of malaria elimination . In this22.1Anopheles minimus is the dominant species of mosquito  was used as an indicator of the risk of malaria exposure in the population and sample sizes calculated for the different transmission settings were based on the value of SCR. In this study, as China was malaria free, the local parasite prevalence was defined as 0. Sample size was estimated based on previous study on size determination for estimating antibody seroconversion rate , for a r2.3After informed consent was obtained from all subjects, their demographic characteristics and behavioral and travel-related information were collected with a standardized questionnaire, using an E-data system. All data were uploaded and stored in a secure database at National Institute of Parasitic Diseases, China CDC.Finger-prick blood was collected from all subjects for the diagnosis of malaria with a rapid diagnosis test (RDT) . The finger-prick blood was also spotted onto filter papers , air-dried, and stored in individual sealed plastic bags with desiccant in a temperature-controlled facility until molecular and serological analysis.2.42.4.1Plasmodium DNA was extracted from the dried blood samples on 3MM filter paper with the QIAamp 96 DNA Blood Kit , according to the manufacturer’s instructions. A real-time reverse transcription ultrasensitive polymerase chain reaction (PCR) analysis was performed following published methods, with an estimated limit of detection of 16 parasites/mL , diluted in Phosphate Buffered Saline (PBS) to a concentration of 3.32 mg/mL, was used in the serological test. Carboxylated Luminex beads with different fluorescent moieties  were covalently coupled with bovine serum albumin (BSA) and the PvMSP-119 antigen, using the modified protocol of Bio-Rad, as follows. The beads (5 × 106 per assay) were resuspended in 80 μL of activation buffer  and activated with 10 μL of 1-ethyl-3-(3dimethylaminopropyl) carbodiimide hydrochloride  and N-hydroxysulfosuccinimide . The activated beads were washed and resuspended in 100 μL of PBS (pH 7.4). The beads coupled beads with 8.0 μg of PvMSP-119 antigen were resuspended in storage buffer and stored at 4°C in the dark.The recombinant blood-stage 2.6The tested sera were isolated from blood spots eluted from 903 filter paper and diluted 1:4 before testing. Antigen-coated beads were thoroughly resuspended and diluted to a final concentration of 80 beads/μL. The secondary antibody , diluted 1:500 (1 μg/mL), was added and the beads were resuspended in 100 μL of PBS (pH 7.4) before analysis on Bio-Plex 200 system. The results were expressed as median fluorescence intensities (MFI). The cut-off value was defined as the MFI of the antibody in the negative control plus three standard deviations. Samples with an MFI value exceeding the cut-off value were determined as antibody positive.2.72 test and Fisher’s exact test were used to evaluate the differences in seroprevalence among the different groups. A reversible catalytic model (a/(a+b)] × [1 − e−(a+b)t], where a refers to the SCR from negative to positive; b refers to the SCR from positive to negative; and t is time. The seropositivity rates in the different defense areas were fitted according to subject age. The parameters of the seroconversion rate were estimated with Muench’s nomogram for the reversible catalytic model (2 test (α =0.05) in GraphPad Prism 8.4.2 . According to the parameters estimated with the best model, the curve-fitting equation for the seropositive rates in the three different line-of defense area was obtained, and the fitting curves for the different age groups and areas were plotted. Maps were created with ArcGIS 10.1 . A P value < 0.05 was deemed to indicate statistically significant differences.All statistical analysis was performed with the statistical software SAS 9.4 . A χic model  was usedic model . The fit33.1The field work was conducted in August–September, 2021. The total number of participants enrolled was 923, and the first-, second-, and third-line-of-defense areas contributed 327, 316, and 280 enrollees, respectively Table 1.P. vivax, and was deemed to be an imported case. All the samples were tested with ultrasensitive PCR, and only one was P. vivax positive, the RDT-positive subject mentioned above.The ratio of females to males was 0.97:1. The majority of participants  were aged > 36 years. The age distribution differed slightly among the different areas, and the highest percentages were aged 6–15, 46–55, and 36–45 years in the first-, second-, and third-line-of-defense areas, respectively. Of the participants, 12.46% (115/923) had been exposed to malaria infection at least once in the past, and this value increased as subjects lived closer to the border. One participant who had a history of travel to Myanmar was RDT-positive for 3.2Plasmodium antigen PvMSP-119 IgG positive were 42, 44, and 10 in the first-, second-, and third-line-of-defense areas, respectively. The prevalence of anti-PvMSP-119 IgG was 12.84% [95% confidence interval (CI): 9.22%–16.47%], 13.93% (95% CI: 10.11%–17.74%) and 3.57% (95% CI: 1.40%–5.75%), respectively. The prevalence of anti-PvMSP-119 IgG differed significantly among three line-of-defense areas on a χ2 test and Fisher’s exact test (P < 0.0001). A paired analysis was used to determine the difference between each two pairs. There was no significant difference between the first- and second-line-of-defense areas (P > 0.05). When the first- and second-line-of-defense areas were combined and then compared with the third-line-of-defense area, the difference was significant (P < 0.0001).The numbers of participants showing 3.32 test (P > 0.05). When the differences between each line-of-defense area were analyzed separately, there was also no statistically significant difference (P > 0.05). The age-specific seropositive rates were calculated in the different line-of-defense areas  and 9.67% (44/455), respectively, which did not differ significantly on a χse areas Figure 23.42 = 0.8582, P < 0.05). There was no significant difference between the fitted value using the reversible catalytic model and the observed value when the goodness-of-fit was evaluated with the χ2 test (P > 0.1).In terms of the conditions of the reversible catalytic model and the increasing trend in the age-specific seropositivity rates, the reversible catalytic model was fitted using the prevalence of IgG antibody positivity. The model indicated that the rate of conversion to seropositive were 0.0042, 0.0034, and 0.0032 in the first- and second-line-of-defense area and total areas, respectively, whereas the rate of reversion from seropositive to negative were 0.0024, 0.0004, and 0.0065, respectively Table 2.The curve fitting equation for the antibody positive rate was obtained using the parameters estimated with the reversible catalytic model Figure 34Plasmodium-species-specific antibodies as biomarkers, and has significant potential utility in enhancing the effectiveness of malaria control and elimination programs , the erythrocyte binding protein (EBP), the merozoite surface proteins (MSPs), apical membrane antigen 1 (AMA1), glutamate-rich protein-R0 (GLURP-R0), and liver-stage antigen 1 (LSA-1). PvMSP-119 is the most immunogenic antigen of P. vivax evaluate the cumulative exposure risk in an investigated population  among three line-of-defense areas. These results may be attributable to differences in the exposure risk and geographic locations of these areas, because the villages from the first- and second-line-of-defense areas were in Nabang Township, adjacent to Laiza City, Kachin State, Myanmar, which reported thousands of cases of malaria annually , whereas no children aged 1–5 years were antibody positive. The seroprevalence in adults reflected the exposure to infection over a longer time period (P. vivax with residual dormant stages in the liver and periodic relapses (P. vivax infection might lead to relapse and seropositivity over a prolonged period. While, the seropositivity in younger children could reflect the recent malaria exposure rates and transmission intensities. The prevalence of antibodies in children aged 1–5 years in three line-of-defense areas were all zero, which strongly supported the indigenous malaria transmission has been suppressed in recent years in the study areas. Moreover, the fitting curve based on the age-specific antibody positivity rates also predicted that the exposure risk of malaria in the 1–5 year age group was 0, which proved the absence of local transmission in the malaria elimination phase, and provided a serological basis for the local confirmation and consolidation of malaria elimination. A similar study in Sri Lanka based on a serological survey after the declaration of malaria elimination also showed that seropositivity in the child group was 0 (In this study, the prevalence of PvMSP-1e period  and sevee period . Populate period , which wrelapses , populatup was 0 .19 antibody positivity increased with age in all the study areas. The risk of malarial exposure predicted with the reversible catalytic model showed that the seroconversion rates in the first- and second-line-of-defense areas were 0.0042 and 0.0034, respectively. The predicted rate was much lower than in other studies that used the same serological marker, PvMSP-119. Two studies undertaken in Cambodia in 2005 and 2011 found seroconversion rates of 0.184 in 2005 and 0.011 in 2012 (In this study, the results showed that the prevalence of PvMSP-1 in 2012 . Another in 2012 , which wAlthough this serological survey showed that seroconversion rates were lower in a post-elimination setting, there was still a risk of exposure to malaria among the populations in the first- and second-line-of-defense areas. When moving into the elimination or post-elimination phase, local transmission is zero, but the potential risk of malaria re-establishment does not disappear, especially in border areas where malaria is still endemic on the other side of the border. Migrant population crossing the border and the lack of barriers to malarial vectors are also challenges to the maintenance of a malaria-free status. Although great achievements have been made in eliminating indigenous cases of malaria in China, the elimination campaign still faces challenges in regions close to international borders . It is d5P. vivax, no standardized serological marker is currently available. In this study, only one antigen, P. vivax antigen PvMSP-119, was used in the serological test. Second, the catalytic model was used at the population level, so individual information and other related factors were ignored. Third, the study sites were only selected in border areas with a potentially high risk of re-establishment.This study had several limitations. First, although multiple serological assays have been used to measure the transmission of 6This is the first serological report to estimate the exposure risk of a population in the post-elimination phase of malaria in China. It indicated that the prevalence of anti-malaria antibody positivity was relatively low in the post-elimination setting, although an exposure risk persisted. Serological surveillance should be considered in the post-elimination setting to provide valuable information about the potential re-transmission risk in post-elimination settings.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.FH and Z-GX conceived and designed the study; FH and YC carried out the data analysis. YC and SW conducted the laboratory work. SL and XRG collected the field samples. FH drafted the initial manuscript. ZH and XG contributed to data review and manuscript revision. All authors contributed to the article and approved the submitted version.